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General NPI Number Information
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NPI Number | 1104083351
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR INSTITUTE OF JACKSONVILLE P A
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 1406 RIDGETREE TRAILS DR
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City | WILDWOOD
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State | MO
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Zip | 63021-5930
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Country | US
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Telephone | 904-998-7747
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 RIDGETREE TRAILS DR
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City | WILDWOOD
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State | MO
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Zip | 63021-5930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH ANDREW MOORE
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Credential | MD
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Telephone | 904-998-7747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME86388
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License Number State | FL
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